Treat everyone as donors, says chief doctor

I'm with him. So many people who don't object to having their organs transplanted just never get around to registering. I think registering against it is a better idea.

I agree.

Me too.

Robin Cook must be clairvoyant.

I have yet to see an "Opt In" program that didn't seem to take advantage of peoples inclination to procrastinate. Truely, I own my body. It should be treated the same as any other possesion at time of death.

There are a number of issues with an opt-out program. First and foremost it has the same problem as the opt-in program, people's natural procrastination. Say someone doesnt opt out of the program through lack of understanding how to, or just cause of sheer laziness. That person gets into a car accident and is "clinically dead" and is harvested. Family members show up and freak out cause their religious beliefs prohibit disturbing a body.

Secondly a persons body should be considered their personal property. You should have to express consent to donate or "will" your body just as you have to for your personal belongings. With lack of formal documentation its left up to next of kin like in the current system.

Its a great idea and would undoubtedly help alleviate the organ supply problem, but you cant just assume donation by lack of written instructions otherwise. Thats the equivalent of going into someones house, raiding their pantry and donating the canned goods to charity simply cause they didnt sign a written form saying you couldn't.

Should organ donation be automatic or personal choice
The Big Question: Should organ donation be automatic or a matter of personal choice?
By Jeremy Laurance, Health Editor
Published: 18 July 2007
Independent UK

Why are we asking this question now?

Yesterday, the Government's chief medical officer Sir Liam Donaldson proposed a radical solution to the shortage of donor organs available for transplant. Everyone should become a potential organ donor at death unless they opt out, he said.

Why is this necessary?

The country faces a "crisis", caused by increasing demand for organ transplants and a declining supply, Sir Liam said.

The average wait for a kidney is over two years. One in 10 people waiting for a heart transplant dies before they can have the surgery. There are more than 8,000 people on the waiting list for a transplant, but fewer than 3,000 operations were carried out last year. The waiting list has increased by more than 1,000 patients since 2003.

Why has the supply of organs declined?

Because our cars and roads are safer than they used to be. Road accident victims were the chief source of organs for transplant but the number of deaths on the roads has fallen sharply. Better designed cars with crumple zones and roll bars, increased use of seat belts and airbags are responsible.

Most organs come from people who have died while on a life support machine in an intensive care unit in hospital - often this may be following an accident.

How would Sir Liam's 'opt-out' scheme work?

At present, anyone who wants to donate their organs after their death must register with UK Transplant or carry a donor card. The NHS Organ Donor Register currently has less than a quarter of the population on it. Campaigns to persuade more people to sign up have had little impact.

An opt-out scheme, also called "presumed consent", would be a mirror image of this. Everyone would be automatically registered on the NHS Organ Donor Register unless they specifically request otherwise.

Under the scheme, people would have to register to say they do not want to be donors, rather than that they do. Sir Liam said there would have to be "absolute clarity" that people had the right to opt out.

An audit of 341 intensive care units in the UK suggested that there was potential to double the number of donors if an opt-out scheme were introduced, Sir Liam said.

How does the UK compare with other countries?

Badly. Our organ donation rates are barely a third of those in Spain and roughly half of those in the US and Austria. We are near the bottom of the league. Spain is among several European countries that operate an opt-out system and its National Transplant Organisation has been acclaimed for its high donation rates.

Since 1990, when the organisation was founded, donor rates in Spain have doubled from 17.8 per million population to 35.1 million nationwide. Austria has also increased its donor rate since introducing an opt-out scheme.

When Belgium switched to a similar scheme, there was an increase in donations at the hospitals that introduced it, but no increase at those hospitals that remained on the old scheme.

Has Sir Liam changed his mind?

Hard to be sure - but it looks that way. In 2003, the Department of Health, of which he was the Chief Medical Officer, opposed proposals to introduce an opt-out scheme during the passage of the Human Tissue Act. Now he faces a struggle to change the minds of MPs, who voted down the proposal.

What do the public think of the idea?

In 1999, the Department of Health justified its opposition to an opt-out scheme by citing a survey of public opinion showing that just 28 per cent backed it compared, with 50 per cent who favoured the existing law.

Yesterday, Sir Liam said surveys showed 70 per cent of the population were willing to donate their organs but only 20 per cent were on the organ donor register.

That is not quite the same as backing a change in the law, however. Sir Liam acknowledges there is a risk that such a move might be viewed as a "totalitarian" approach. Britain places a higher value on individual autonomy than some other countries.

Do medical organisations support the move?

Broadly yes. The British Medical Association has backed a change in the law since 1999, after supporting the existing opt-in scheme for the previous 30 years. The Royal College of Pathologists is also in support. But Keith Rigg, of the British Transplant Society, said the decision on whether to donate "should not be left to a default position".

Would it work?

This is the $64,000 question - and the answer is far from obvious. Sir Liam made great play of the Spanish experience yesterday - but UK Transplant, responsible for administering the National Donor Register, cast it in a different light.

According to UK Transplant, Spain changed the law to introduce its opt-out scheme in 1979. However, it had no impact until the Spanish government appointed donor transplant co-ordinators in every intensive care unit in 1989. The co-ordinators' job was to negotiate with relatives when a patient died to gain consent for removal of their organs, and it was this that led to the rapid increase in donor rates.

Rafael Matesanz, director of the Spanish National Organisation for Transplants, wrote earlier this year: "The increase in organ donation during the 1990s cannot be attributed to any change in Spanish law."

Hasn't the UK law given people the right to decide whether to donate?

Yes and no. Since the Human Tissue Act took effect in 2006, a donor's wishes take priority over their relatives. In practice, however, it is difficult for doctors to take a patient's organs without the consent of relatives - who often do not know what the wishes of the deceased were.

Many people who sign on to the donor register in the UK do so without telling their families. No doctor wants to wave the law in the face of grieving relatives, and they often need sensitive information about the deceased in order to use their organs for transplant which is harder to obtain if the family is uncooperative. This makes the consent of relatives as important as it ever was - a fact the Spanish system has recognised and addressed.

Should the law be changed so that everyone is considered a potential organ donor?

Yes...

* There is currently a desperate shortage of organs available for transplant

* Countries that have introduced opt-out schemes have seen their donor rates rise

* Seven out of 10 people say they are willing to donate their organs, but only two in 10 are registered

No...

* Protecting individual autonomy is more important than boosting transplant rates

* Even if the law is changed, consent from relatives will still in practice be required

* Appointing transplant coordinators, as in Spain, would have more impact than changing the law

I'm against changing from opt-in to opt-out. I don't want the state to make it in anybody's interest that I die, and then make me responsible for reversing that.

Thomas, trust me no doctor would simply give up on a patient simply cause they want to harvest the organs. When someone is considered for organ donation it means they have no higher brain function and never will. Any cases to the contrary are misdiagnosis by the attending physician and not attempts to harvest before the patient is truly dead.

No offense, but I don't know you. How can you expect me to trust you?

BDoug, you can't really say 'no doctor'... there are some pretty shady characters out there.

I would prefer to have to sign my organs away, rather than have it be assumed I'd be willing to donate them. Then it's clear that it was a conscious decision on my part, registered with the authorities and my family would probably feel more at ease with the donation.

True you don't know me...but Im a cool guy, I swear! lol

And true there are shady characters in the medical profession, but there are shady characters everywhere, that's unavoidable. Luckily there is always more than just one person working with a patient at a time. I think it would be hard to find a consensus among a group of individuals who pledged to help people, that a person is dead before their time just to harvest their organs. (not to mention there are strict guidelines as to when a person can be considered for organ donation)

Well, I used to work with doctors, so I have a biased opinion. Some are good, some are great, and some are in the wrong profession. You can't trust someone just because they took the Hippocratic Oath and vow to uphold life.

I grew up with nurses and now Im going to med school to be a PA. I understand you get your fair share of great doctors but also your share of raging @ssholes. But I think their insufferable attitudes stop short of murder....